ESPN 51th Annual Meeting

ESPN 2018

The role of hemopexin in the pathogenesis of idiopathic nephrotic syndrome (INS)

AGNIESZKA PUKAJLO-MARCZYK 1
DANUTA ZWOLINSKA
1

1- WROCLAW MEDICAL UNIVERSITY, DEPARTMENT OF PEDIATRIC NEPHROLOGY

Introduction:

Hemopexin (Hpx) as a circulating glomerular permeability factor is taken into account in the pathogenesis of INS. It has been shown that activated Hpx induced reversible proteinuria and podocyte foot process effacement in rats.

The aim of this studywas to evaluate serum and urinary Hpx levels and to determine its role in the proteinuria development and the usefulness as disease prognostic markers.

Material and methods:

The study involved 51 INS children, who were divided into subgroups according to the relapses number (the first incident (F-INS) vs subsequent relapses (R-INS) and on the treatment modality {glucocorticoids (GS) vs GS and additional immunosuppressants (AI)}. Patients who underwent renal biopsy, were divided into subgroups based on histopathological diagnosis.18 healthy children served as control. Serum and urinary level of Hpx in active phase and remission were measured using an ELISA assay.

Results:

In active phase of INS Hpx was significantly increased, both in serum and urine compared to controls. In remission these values became reduced, but still remained significantly higher than in controls. Additionally, urinary Hpx in remission was significantly elevated in R-INS compared to F-INS group. In the GS subgroup urinary Hpx in acute phase was significantly higher and in remission lower than in AI. Urinary Hpx in MGN (mesangial GN) compared to MCD was significantly higher.

Conclusions:

The significant increase of serum and urinary Hpx level in acute INS phase and its lowering in remission suggest that Hpx play an important role in the pathogenesis of INS. Still significantly higher Hpx values in remission compared to controls points on persistence of immune system activation and the need for further treatment. Urinary Hpx may useful as a prognostic marker of INS course.